Provider Demographics
NPI:1184144552
Name:AMUNDSEN, INC.
Entity type:Organization
Organization Name:AMUNDSEN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUNDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BCAO
Authorized Official - Phone:707-763-1156
Mailing Address - Street 1:1112 B ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4054
Mailing Address - Country:US
Mailing Address - Phone:707-763-1156
Mailing Address - Fax:707-763-1177
Practice Address - Street 1:1112 B ST
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4054
Practice Address - Country:US
Practice Address - Phone:707-763-1156
Practice Address - Fax:707-763-1177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty